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Linking Traumatic Events & Pain Severity

J Pain; ePub 2016 Sep 15; Nicol, Sieberg, et al

Affective distress and fibromyalgia-ness interact to play key roles in the association between abuse and pain, a recent study found. A cross-sectional analysis of 3,081 individuals presenting with chronic pain was performed using validated measures and a history of abuse was assessed via patient self-report. The aim was to determine the associations between a history of lifetime abuse and affective distress, fibromyalgia-ness, pain severity and interference, and physical functioning. Researchers found:

  • Individuals with a history of abuse (n=470; 15.25%), had greater depression, greater anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the fibromyalgia survey criteria.
  • Fibromyalgia survey score and affective distress independently mediate the relationships between abuse and pain severity and physical functioning.
  • Pain patients with a history of lifetime abuse portend a worse clinical phenotype.

Citation:

Nicol AL, Sieberg CB, Clauw DJ, Hassett AL, Moser SE, Brummett CM. The association between a history of lifetime traumatic events and pain severity, physical function, and affective distress in patients with chronic pain. [Published online ahead of print September 15, 2016]. J Pain. doi:10.1016/j.jpain.2016.09.003.

Commentary:

This study is a good reminder that pain, as well as the functional and affective effects of pain, are influenced by many things. One important influence is a history of abuse earlier in life. The importance of understanding this is that when we treat pain utilizing only pain medications without delving further into a patient’s psychosocial background, we miss some of the most important opportunities we may have to understand a patient’s experience, and therefore to help them deal with and perhaps overcome their experiences. Excellent pain programs utilize multi-model approaches that include psychological therapy, goal-directed therapy like CBT, and pain medications to achieve optimal results. —Neil Skolnik, MD